This proposal is a revision of 1RO1HD069221. We are addressing the need for innovative research on prevention in the context of emergency medical services, specifically evaluation of behavior change interventions using computer technology. We propose to test a web based, theory driven, computer-tailored intervention for child passenger safety in two Pediatric Emergency Departments (PEDs) and a Level 1 Pediatric Trauma Service (PTS) that serve diverse populations. The focus of this proposal is on parents' use of child restraint devices (CRDs) -- Car Safety Seats (CSS) and Belt-Positioning Booster Seats (BPBS) -- for their children ages 8 years and younger. These safety behaviors were chosen because they are effective countermeasures known to help prevent motor vehicle occupant injuries, the leading cause of child mortality in the United States. Although CSS use with younger children is common, there are disparities across populations, BPBS use for older children is low, and misuse of CRDs is widespread. Our previous work, including the NICHD-funded study of Safety in Seconds (SIS) and that of others, has demonstrated that computer-tailored interventions can be feasible and effective in clinical settings, including PEDs. However, our work is the only research to our knowledge applying this technology to the specific issues of CSS and BPBS and the first to use it with Spanish speaking families. The original SIS was a kiosk-based, computer tailored program that demonstrated some success in a low income, urban, and predominantly African-American population in a single PED. This proposal will test an enhanced web-based program, Safety in Seconds v 2.0 (SIS v2.0), with English and Spanish speaking families from Baltimore, MD and Little Rock, AR. We will also extend our prior work by adding several elements never previously considered: testing the program in a PTS; testing a Spanish language version; and adding text messaging reminders and a web portal that can be accessed multiple times to reinforce the educational messages. Evaluating the program's cost benefit and determining barriers and facilitators to program adoption and implementation are also innovative aspects of the proposed work that will contribute to future dissemination. The specific aims of the study are to: 1) evaluate the impact of a web-based, tailored program on English and Spanish speaking parents' child passenger safety knowledge, prevention beliefs, and the proper and consistent use of CSS and BPBS for their children ages 0-8; 2) evaluate the cost benefit ratio of the program for parents' utilization of BPBS for their children; and 3) determine the barriers and facilitators to program adoption and implementation in both PED and PTS settings. This 5-year study will take place in the Johns Hopkins PED (JH-PED) and the Johns Hopkins PTS (JH-PTS) as well as in the Arkansas Children's Hospital PED (AR-PED). Methods include: a) a modification of the existing Safety in Seconds program to convert it to a web-based platform and incorporate additional video, audio, texting reminders and repeat visit capabilities; b) a randomized controlled trial with 1,650 parents (600 JH-PED, 450 JH-PTS, 600 AR-PED), including baseline and 6-month follow up assessments and CSS observations; c) a cost benefit analysis of the program's expected financial benefit from the perspective of a third party payer of medical claims; and d) an in-depth examination of program adoption and implementation in all three study settings using qualitative data collected from key informant interviews, direct observations of the clinic environments, and document review. With the ever-growing access to computers, results of this work will have widespread utility for disseminating effective CSS and BPBS behavior change programs to a broad audience, and we will advance the application of computer tailoring theories and methods in a new area. PUBLIC HEALTH RELEVANCE: This proposal will evaluate an innovative web-based program -- Safety in Seconds v 2.0 - to increase the proper and consistent use of Car Safety Seats and Belt-Positioning Booster Seats for children ages 8 years and younger. Motor vehicle crashes are the leading cause of death for children and child restraint devices are proven to reduce the risk of death and injury. The program will be evaluated in pediatric emergency departments and a pediatric trauma center with both English and Spanish speaking families. We will also complete a cost benefit analysis of the program and a study of how to implement the program in other settings.